Remote-Eligible Senior Workers' Comp Claims Examiner

Athens Administrators, Inc.; Agoura Hills (CA); Hybrid; USD 85,000 - 100,000; Full time

Job summary

Athens Administrators in California seeks a Senior Claims Examiner to support workers' compensation cases. The role requires handling claims from inception through settlement, adjusting reserves, and directing medical treatment.

This is a full-time, hybrid position with occasional in-office days for Ventura County client reviews. The candidate should have 3+ years of WC claims handling, an active Claims Adjuster designation, and strong negotiation skills.

Qualifications

• High School Diploma or equivalent required.
• AA/AS or BA/BS preferred but not required.
• Administrators Certificate from Self-Insurance Plans within one year of employment.
• Must possess a current Experienced Indemnity Claims Adjuster Designation.
• 3+ years recent workers' compensation claims handling experience.
• At least 5 years of workers' compensation claims experience preferred.
• Solid knowledge of workers' compensation laws, policies, and procedures.
• Proficiency in determining case value and negotiating settlements.
• Strong attention to detail and ability to multi-task.
• Excellent verbal and written communication skills.
• Ability to work effectively with attorneys, doctors and clients.

Responsibilities

• Establish contact with employer to review issues.
• Respond to inquiries from the employer, employee, doctors, and attorneys.
• Establish and maintain appropriate reserves.
• Review legal correspondence and medical reports.
• Evaluate and approve medical procedures and treatment.
• Administer benefits and ensure appropriateness of all payments.
• Investigate coverage, liability, and monetary value of claim.
• Review medical and legal bills for appropriateness.
• Negotiate settlements and monitor litigation when needed.
• Prepare reports and communicate with clients.
• Provide direction to support staff and trainees as needed.
• Collaborate with attorneys on settlements and litigation strategies.

Skills

Verbal communication

Written communication

Organizational skills

Analytical skills

Problem solving

Microsoft Office Suite

Fast typing

Education

High School Diploma or equivalent

Administrators Certificate (Self-Insurance Plans)

Experienced Indemnity Claims Adjuster Designation

Tools

Microsoft Office Suite

Job description

Athens Administrators in California seeks a Senior Claims Examiner to support workers' compensation cases. The role requires handling claims from inception through settlement, adjusting reserves, and directing medical treatment.

This is a full-time, hybrid position with occasional in-office days for Ventura County client reviews. The candidate should have 3+ years of WC claims handling, an active Claims Adjuster designation, and strong negotiation skills.